Overtesting HbA1c in Diabetes Patients is Adding Burden, Study Finds

A report from the Mayo Clinic shows a nationwide trend toward overtesting HbA1c levels in adults with type 2 diabetes. Findings from the study are published in The BMJ.

Overtesting HbA1c can result in unnecessary costs, time burden, and waste, researchers stated. Overtreatment with hypoglycemic drugs can also add extra cost and possible health complications. The lower thresholds of testing frequencies are commonly discussed, but the upper thresholds are not well defined. Most professionals agree that testing once or twice a year is sufficient for adults who are not on insulin therapy, have stable glycemic control within recommended targets, and have no history of severe hyperglycemia or hypoglycemia. However, a much higher incidence of excessive testing is found in practice.

Rozalina McCoy, MD, the study's lead investigator, and her colleagues examined 31,545 non-pregnant adults with controlled type 2 diabetes that were not being treated with insulin. The study data was from the OptumLabs Data Warehouse encapsulated the time period of 2001–2011. Over half of the patients (55%) in the cohort achieved and maintained the recommended <7% HbA1c level and were tested 3 or 4 times per year; 6% of patients were tested ≥5 times. Among patients receiving bundled testing (eg, cholesterol, creatinine, and HbA1c tests in the same day), there was a lower rate of overtesting.

Study authors attribute possible reasons for frequent testing to clinical uncertainty, fragmentation of care, the need to fulfill regulatory demands, or internal tracking of performance. They concluded that healthcare providers "must be ever vigilant to provide the right testing and treatment to our patients at the right times."